Healthcare Provider Details

I. General information

NPI: 1649753146
Provider Name (Legal Business Name): FAMILY MEDICAL CENTER OF MICHIGAN,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 ESSEX AVE RM 211
DETROIT MI
48215-3243
US

IV. Provider business mailing address

8765 LEWIS AVE
TEMPERANCE MI
48182-9583
US

V. Phone/Fax

Practice location:
  • Phone: 734-654-2169
  • Fax:
Mailing address:
  • Phone: 734-847-3802
  • Fax: 734-850-0520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number State

VIII. Authorized Official

Name: ED LARKINS
Title or Position: CEO
Credential:
Phone: 734-850-6914